Hemorrhoids natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Younes M.B.B.CH [2]

Overview

If left untreated, hemorrhoids may lead to strangulation, anemia, or fecal incontinence. Common complications of hemorrhoids include secondary infection, thrombosis, or strangulation. Prognosis is generally excellent and most cases respond to non surgical treatment. However, surgery gives the best prognosis with the least recurrence rate.

Natural History, Complications and Prognosis

Natural History

  • Myths about the surgical treatment
  • Postoperative pain
  • Fear of incontinence after surgery[1]

Complications

Most common complications

Less common complications

Complications due to surgery

Prognosis

  • The prognosis is excellent.
  • Most cases respond well to non surgical procedures such as rubber band ligation (recurrence rate is 30-50% after 5 years); however, the recurrence rate is much less with surgical hemorrhoidectomy (2-5% after 5 years).[2][3]
  • The difference in recurrence rate is more pronounced with grade III hemorrhoids.

References

  1. Guttenplan M (2017). "The Evaluation and Office Management of Hemorrhoids for the Gastroenterologist". Curr Gastroenterol Rep. 19 (7): 30. PMID 28567655. doi:10.1007/s11894-017-0574-9. 
  2. Jayaraman S, Colquhoun PH, Malthaner RA (2007). "Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery". Dis. Colon Rectum. 50 (9): 1297–305. PMID 17665254. doi:10.1007/s10350-007-0308-4. 
  3. Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA (2005). "Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids". Cochrane Database Syst Rev (3): CD005034. PMID 16034963. doi:10.1002/14651858.CD005034.pub2. 

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